Everyone is familiar with oral herpes, but can herpes also develop on the genitals?

Author: Wu Hao, Chief Physician, Beijing You'an Hospital, Capital Medical University

Standing Committee Member of the Infection and Immunity Branch of the Chinese Medical Association

Reviewer: Chen Yong, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

We have all seen oral herpes. Many people will develop herpes on their lips after catching a cold, and it will heal on its own after a period of time.

In fact, herpes can also develop on the genitals.

1. What is genital herpes?

Genital herpes is a skin disease caused by the herpes simplex virus infecting the genitals.

Herpes simplex virus is divided into type 1 and type 2. Oral herpes is often caused by type 1, accounting for about 90%, and type 2 accounts for 10%. Genital herpes is mainly caused by type 2 virus, accounting for about 90%, and type 1 accounts for 10%.

Figure 1 Original copyright image, no permission to reprint

The pathogenesis of oral herpes and genital herpes is similar. It is a latent infectious disease. The herpes virus usually lurks in the cervical ganglia or sacral ganglia. The herpes virus runs out of the ganglia, runs to the lips and genitals, and causes oral herpes and genital herpes.

Under what circumstances will the herpes virus come out?

The mechanism is not very clear at present. Taking oral herpes as an example, it is believed that fatigue, drinking, colds, etc. can induce herpes, especially severe colds and fever. On the third day when the cold is almost healed, herpes will start to appear on the lips.

How genital herpes is transmitted has not been clearly studied yet. According to statistics from STD clinics, the incidence of genital herpes is about 1%-2%. In fact, the positive rate of herpes virus antibodies is 50%-70%. Most people do not develop herpes after being infected with the herpes virus. It is very likely that they have only formed a latent infection, and only 1%-2% develop genital herpes.

If you are infected with the herpes virus and have herpes on your genitals, it is definitely contagious and can be transmitted through sexual contact. There is currently controversy over whether it is contagious if you do not have herpes but just carry the virus on your skin. There is no definitive answer yet.

2. What does genital herpes look like?

Genital herpes mainly causes blisters to form in the area where the sacral nerves are distributed. The course of the disease is about 10-20 days, and it is similar to oral herpes.

The typical symptoms of genital herpes are that macules appear at first, which gradually rise above the skin surface and become papules, and then blisters form. After the blisters burst, ulcers form. This is basically the process.

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But most genital herpes symptoms are not typical. Some are just a few small papules without blisters behind them; some are blisters without rupture or ulceration. The duration of herpes depends on whether blisters appear. If blisters do not appear, sometimes it will heal in three to five days. Herpes may also cause fever, but generally there are no other symptoms.

There is no special test for genital herpes. You can draw blood to check whether IgG and IgM antibodies are positive, but since 50%-70% of patients in STD clinics have positive blood tests, it is not very meaningful. Most hospitals cannot test for herpes virus locally.

The symptoms of genital herpes are typical and are actually not difficult to diagnose. You can tell at a glance. For atypical symptoms, most cases are diagnosed by repeated attacks in the same area.

3. How to treat genital herpes?

No one will seek treatment for oral herpes, which is harmless to the body. But everyone is very afraid of genital herpes and wants to cure it, firstly because they are afraid of infection, and secondly because everyone has heard that it is incurable.

Theoretically speaking, genital herpes is indeed not easy to cure because it is a latent infection and the virus is always lurking there. However, clinically, it can be treated to prevent it from occurring for life, which is actually equivalent to a cure, or the recurrence rate can be reduced to less than three times a year.

Genital herpes is very easy to control. It takes about 10 days of acyclovir, which is one course of treatment, to control it. However, acyclovir has a disadvantage. It is not easily absorbed orally and needs to be taken five times a day. There is another drug called valacyclovir, which only needs to be taken twice a day. The blood drug concentration is relatively stable. It is converted into acyclovir in the body to exert its effect. The course of treatment is also about 10 days.

About 30%-50% of genital herpes patients can be cured with one course of medication.

However, some patients will relapse after one treatment. Suppression therapy can be used, which means taking medicine continuously for half a year to a year after being cured, which can control the herpes virus.

Some patients take medicine every time they have a relapse, and do not take medicine when there is no relapse. They can be cured by taking medicine three or five times. After a relapse, start taking medicine two days before the onset of herpes. It is best to prevent the herpes from growing. Take medicine for prevention. Even if it grows again later, it will only last for a short period of time.

Some interferon ointment can also be used externally to relieve pain, disinfect and shorten the course of the disease.

Figure 3 Original copyright image, no permission to reprint

Generally speaking, genital herpes is easy to treat.

So, can genital herpes get better without treatment? Genital herpes is the same as oral herpes. It will get better without treatment. If it recurs less than 3 times a year, it can be cured slowly without treatment and will not affect the quality of life. If it recurs more than 6 times a year, it will obviously affect the quality of life and requires thorough treatment. After treatment, it can be controlled.